WASHINGTON—Ohio doctors prescribed more than 684 million doses of opioid painkillers in 2015, nearly 60 pills for every man, woman and child in the state.

These aren't "dirty doctors” operating pill mills, experts say. They're either treating patients with chronic pain—or are quick to order up a bottle of Percocet for a sprained ankle when a couple of Advil would do.

Now, several lawmakers in Washington are writing their own prescription for America’s doctors: mandatory training on non-opioid pain treatments and on how to detect signs of substance abuse.

It’s a controversial proposal that could spark opposition from opioid manufacturers that don’t want doctors cutting back on profitable painkiller prescriptions—and from doctors who don’t want Washington lawmakers meddling in their medical decisions.

Dr. Mark Piacentini, who treats recovering addicts in Ohio's Marion County, said the bill could inadvertently push more people to use heroin if doctors become afraid to prescribe painkillers.

The battle comes as Congress is increasingly focused on the epidemic, which has ravaged Ohio and reached into nearly every other corner of the country. As early as next week, the Senate will take up legislation that would expand treatment, increase access to an opioid overdose antidote, and divert some drug offenders from jail to rehab programs.

That legislation, sponsored by Sens. Rob Portman, R-Ohio, and Sheldon Whitehouse, D-R.I., has broad bipartisan support. But some lawmakers and addiction advocates say it wouldn't do enough to tackle the root problem: widespread over-prescribing of opioids, which has helped fuel the heroin epidemic.

“I’ve heard of dentists giving Vicodin to patients who complain after getting their teeth cleaned,” said Randy Runyon, CEO of the Ohio Association of Community Health Centers.

Runyon and others say some doctors are prescribing such pills too freely--handling out 30 or 60 potent painkillers to patients who don’t need them and don’t understand their addictive powers. Too often, those painkillers end up in the family medicine cabinet, where a curious teenager can find them and end up on a dark path toward heroin addiction.

Nearly 80 percent of heroin users reported using prescription opioids first, according to the National Institute of Drug Abuse, which cited a study of addicts who began abusing in the early2000s. Another study found that 89 percent of young urban heroin users said they started with opioid prescriptions from friends, family members or their own doctor.

That may explain why lawmakers in Washington are as concerned about the medical community’s legal prescribing practices as they are about Mexican drug cartels smuggling heroin across the border.

Stopping the opioid epidemic “starts with the prescribers,” Sen. Edward Markey, a Massachusetts Democrat, said at a news conference earlier this month. “The United States is less than 5 percent of the population of the world, but we consume 80 percent of the world’s opioid painkillers.”

Markey is chief author of the mandatory physician training bill, which he hopes to attach to the bipartisan treatment-and-prevention legislation sponsored by Portman and Whitehouse. Markey's bill would require doctors to undergo training on responsible prescribing of pain medications, alternative non-opioid pain treatments, and methods for diagnosing and treating substance use disorders, among other mandates.

Piacentini, the Marion doctor, said the bill could have an unintended consequence, driving more people to heroin and making them harder to reach.

“I see many patients seeking narcotic drugs and other addictive medicines,” he said. “As regulations get tighter on narcotic prescribing, the addicts will find narcotics in whatever form they can buy.”

Portman and Sen. Sherrod Brown, D-Ohio, support Markey’s bill. Brown, who has offered a similar proposal, said it would help doctors “stay up to date on the best medical research and information, so they can make the best decisions about how to serve their patients and help prevent addiction.”

Ohio doctors don't see it that way. The Ohio State Medical Association opposes any "mandatory pain management training" and highlighted its own voluntary programs. Spokesman Reggie Fields noted that opioid prescriptions in Ohio have declined in recent years.

Local addiction specialists were more blunt, describing Markey’s proposal as burdensome and wrong-headed.

Once they start using heroin, “then they are lost,” Piacentini said. “People just using prescription narcotics are much easier to get into recovery than the hard-core heroin addict.”

He sounded frustrated that lawmakers appear focused on tinkering with training requirements rather than on what doctors say would be most effective: federal dollars for treatment.

“I’m at the same place I was two years ago and four years ago and six years ago,” Piacentini said. “We have 8,000 heroin addicts in Marion County and only about 250 treatment spots available... this law does nothing for the problem as it exists."

Markey and others strongly support expanding treatment. And the underlying Portman-Whitehouse bill would do that, although perhaps not as significantly as Kalfas and others say is needed.

But to prevent people from needing treatment in the first place, Markey and others argue, doctors have to stop handing out so many opioid prescriptions.

It's not clear if powerful drug lobbyists or doctors' groups in Washington will try to kill the bill. A spokesman Purdue Pharma L.P., which makes OxyContin and other opioid medications, declined to comment on the legislation.

The American Medical Association hasn't taken a position on the legislation, but it has quietly suggested the proposal is a one-size-fits-all approach ill-suited for the nuances of medicine or the unique needs of individual patients. As the Senate gears up for debate on the issue, the AMA appeared to make a preemptive move by highlighting its own efforts to educate doctors on the issue.

On Thursday, AMA president Dr. Steven J. Stack issued a “call to action” urging doctors to address the opioid epidemic and blasting out voluntary recommendations for best practices on opioid prescriptions.

Markey says voluntary campaigns and recommendations won't work. The FDA has offered voluntary education sessions for opioid prescribers since 2013, but fewer than 10 percent of physicians have completed the training, according to Markey’s office.

“We need to stop the over-prescription of pain medication that is leading to heroin addiction and fueling this crisis,” Markey said. “And that starts with the prescribers.”